Gastro-intestinal tube with inflatable weight releasing means



6, 1968 R. A. STRATTON ETAL 3,395,710

GASTRO-INTESTINAL TUBE WITH INFLATABLE WEIGHT RELEASING MEANS Filed June14, 1965 INVENTORS F0652 7/415 review 779/ rz h flcxx ATTORNEY! UnitedStates Patent 3,395,710 GASTRO-INTESTINAL TUBE WITH INFLATABLE WEIGHTRELEASING MEANS Robert A. Stratton, 1913 6th Ave., and Fritz Wach, 21767th Ave., both of Yuma, Ariz. 85364 Filed June 14, 1965, Ser. No.463,574 8 Claims. (Cl. 128-350) ABSTRACT OF THE DISCLOSUREGastro-intestinal suction and medication introduction apparatuscomprising a bi-lumenal, flexible tube having a smaller lumen within alarger one and inflatable means near the lower end of the smaller lumenadapted to inflate to substantially constrict the passageway of thelarger lumen; a weighted object, such as a thin-walled rubber bag ofmercury, a flexible element such as a thread secured to the bag and anenlargement secured to the opposite end of the thread from the bag, theenlargement adapted to be releasably retained in the tube larger lumenby inflation of the inflatable means to dispose the weighted bagrelatively freely a short distance beyond the lower end of the tube.

A method of assembling, inserting, employing and withdrawing the tube isalso described.

The foregoing abstract is not intended to be a comprehensive discussionof all of the principles, possible modes or applications of theinvention disclosed in this document and should not be used to interpretthe scope of the claims which appear at the end of this specification.

The present invention relates to improved apparatus for draining andmedicating the gastro-intestinal region.

Gastro-intestinal tubes of the nasally inserted type are generallyflexible, of a diameter sufficiently small to allow introduction of thetube through the patients nasal passage and of a length sufficient topermit the introduced end of the tube to reach the appropriate locationso that gastro-intestinal contents can be removed by suction through theupper end of the tube which projects from the patients nose, or in someinstances, from the patients mouth.

Although it is usually not diflicult to introduce such tubes to thestomach, prior art gastro-intestinal tubes are often found to beunsatisfactory for draining or medicating the small intestine because ofthe difficulty experienced in attempting to pass the lower end of suchtubes through the ring shaped muscle at the lower end of the stomach orin retrieving the tube from the gastro-intestinal tract once the lowerend of the tube has been introduced into the small intestine. To aidpassage of the tube through the ring-shaped muscle at the lower end ofthe stomach, prior art devices have employed means such as bulbousweighted attachments on the lower end of the tube usually in the form ofa thin-walled rubber bag containing air, water, mercury or the like.Progress of the tube lower end is often observed by fluoroscopy or X-raytechniques.

Beside being cumbersome and time-consuming, these procedures aresometimes unsuccessful since the natural tendency of the bulbousweighted object to descend in the gastro-intestinal tract is hindered byits direct attachment to the end of the tube. The feeding of the tubefaster than its rate of descent sometimes causes it to coil in thestomach so that the lower end is not presented at the lower end of thestomach.

In instances where the practitioner is successful in introducing suchprior art weighted bulbous lower end tubes into the small intestine,such difliculty is often encountered in attempting to withdraw the tubefrom the small intestine because of the tortuous passageway thereof and3,395,710 Patented Aug. 6, 1968 the contraction of the ring-shapedmuscles of the stomach about the tube, that the practitioner may be leftwith no alternative but to cut the tube at the nose of the patient andallow the tube to pass through the esophagus and gastro-intestinal tractin the normal manner. Fortunately, when such tubes are out they usuallypass through the patient in about 24 hours, but instances Where suchtubes when cut have taken up to three Weeks passing through have beenreported. Needless to say, such a method causes some consternation toboth the patient and his physician.

Recognizing this problem, others have proposed means for detaching theweighted object from the tube within the patient to facilitatewithdrawal of the tube. Such constructions are exemplified by the tubeshown in the US. patent of Barron, 3,155,097.

A prior art device for gastro-intestinal intubation has provided afeeding tube adapted to be inserted through a patients nose and carriedto his stomach by a mercury filled bag disposed closely adjacent thelower, apertured end of the tube by a suture thread which loops throughone of the apertures and through an eyelet on the bag. The ends of thesuture thread project from the upper end of the single lumen tube. Torelease the bag, one end of the suture thread is pulled and the otherreleased. The latter travels down the tube and upon being withdrawn fromthe bag eyelet, the bag is released. Apparently, when the bag of theprior art device is attached, suflicient tension must be maintained onthe suture thread to key the bag to the tube, otherwise descent of thebag would not cause the tube to be drawn along. The tension on thethread undoubtedly increases the tendency of the tube to kink and at theleast, decrease its flexibility. The size of the looped lower end of thetube of the prior art device would effectively prevent its use in theintestine, since the loop would probably be too large and rigid to passthrough the stomach lower end ring muscle. If it were used as agastro-intestinal tube the tube of the prior art device wouldnecessarily possess many of the above-noted disadvantages of prior artWeighted tubes where the weight is attached closely adjacent the lowerend of the tube. For instance, the release mechanism of the bag of theprior art device, while probably performing Well in the stomach, wouldencounter technical difliculties in the intestine were it used there,due to the necessarily longer tube length and the tortuous path whichwould probably increase suture thread friction against the tube to suchan extent that the thread could not be successfully withdrawn.

Accordingly, it is a primary object of the present invention to provideapparatus useful in intestinal intubation including a flexible tubewhich will readily pass through the muscular contractile ring at thelower end of the stomach, into the upper part of the small intestine, orduodenum, and thence into the remainder of the small intestine ifnecessary and which can be dependably retrieved from this location bywithdrawal through the patients nose or mouth.

A more particular object of the invention is the provision of a flexiblegastro-intestinal tube having a weight releasably attached adjacent itslower end by a cord or the like of appreciable length which allows thebag to freely descend within the gastro-intestinal tract unhampered bythe relative rigidity of the flexible tube, resulting in the pulling ofthe tube by the attached cord along the path traversed by the bag.

A further object of the invention is the provision of improvedgastro-intestinal suction and medication introduction apparatuscomprising a bi-lumenal, flexible tube having a smaller lumen within alarger one and inflatable means near the lower end of the smaller lumenadapted to inflat to substantially constrict the passageway of thelarger lumen; a weighted object, such as a thin-walled rubber bag ofmercury, a flexible element such as a thread secured to the bag and anenlargement secured to the opposite end of the thread from the bag, theenlargement adapted to be releasably retained in the tube larger lumenby inflation of the inflatable means to dispose the weighted bagrelatively freely a short distance beyond the lower end of the tube.

Yet another object of the present invention includes the provision of amethod for reliably accomplishing intestinal intubation and for equallyreliably withdrawing the introduced tube.

These and further objects of the present invention will become moreclearly apparent, as will the principles and scope of advantageousapplicability of the present invention, during the course of thefollowing detailed discussion which relates to the preferred embodimentof the apparatus of the invention that is illustrated in theaccompanying drawing.

In the drawing:

FIGURE 1 is an enlarged fragmentary perspective view of a tube embodyingthe present invention, the wall of the larger lumen being partly brokenaway to expose the smaller lumen, the inflated balloon and the balloonengaging bag retaining block;

FIGURE 2 is a transverse cross-sectional view taken substantially alongthe line 22 of FIGURE 1;

FIGURE 3 is a transverse cross-sectional view taken substantially alongthe line 33 of FIGURE 1;

FIGURE 4 is an enlarged fragmentary perspective view similar to FIGURE1, but showing the balloon in a deflated condition and the weighted bag,thread and retaining block escaping from the tube; and

FIGURE 5 is a fragmentary perspective view of a modification shown in acondition thereof similar to the FIG- URE 1 condition of the preferredembodiment shown therein.

The apparatus includes a tube 12 of soft, flexible material such asrubber or synthetic plastic material preferably having an outsidediameter sufliciently small to permit insertion of the tube in thepatients nasal cavity and passage of the inserted end of the tube downthe patients throat, esophagus and into his stomach and small intestine.For the normal human adult, a tube 12 of approximately ten feet inlength has been found to be adequate and alow a suflicient amount of thetube 12 upper end 14 to extent from the patients nose or mouth after thetube 12 lower end 16 has reached the desired point to permit theattachment of suction, pressure, and other apparatus to the tube upperend.

The tube 12 comprises two lumen-s or channels 18, 20 the former being ofsmaller diameter and disposed within the latter so as to extend from theupper end of the tube 12 nearly to the lower end thereof.

The smaller lumen preferably comprises a flexible tube 21 of flexiblerubber or synthetic plastic material. It may conveniently be attached tothe inner peripheral wall 22 of the larger lumen 20 by solvent welding,heat sealing or any similar technique so as to extend longitudinallyalong. It is also within the purview of the invention that the tube 12be extruded as a unitary biluminal tube utilizing conventional extrusiontechniques and a die or extrusion head having a shape corresponding tothe cross-sectional shape of the tube 12 as shown in FIGURE 2.

Within the larger lumen, near the lower end of the tube 12, aninflatable balloon 24 is provided at the lower terminous of andcommunicated to the smaller lumen. The balloon 24 may be a separatelyfabricated, thin-walled element secured as by heat sealing or solventwelding to the smaller lumen, or it may merely comprise a thin areaformed in the peripheral wall 26 of the smaller lumen itself, similar toaneurysm of a blood vessel, the lower end of the smaller lumen beyondthe thinner section then being closed off by heat sealing, solventwelding or the like.

The balloon 24 is of such elasticity that when inflated 4 itsubstantially blocks the larger lumen (FIGURE 3) and when deflated doesnot obstruct the larger lumen significantly more than does the smallerlumen (compare FIGURES 4 and 2).

To the upper end of the tube 12 may be secured a Y connector 26 having aleg 28 which communicates with the smaller lumen and a leg 30 whichcommunicates with the larger lumen. The leg 28 is preferably connectedto a source of pressurized fluid such as air or water in order toinflate the balloon 24 and maintain it in an inflated condition. Thecommunication to the pressurized fluid is disrupted when deflation ofthe balloon is desired. The leg 30, communicating with the larger lumen,may be connected to a conventional suction device for removinggastro-intestinal contents and subsequently or alternatively toapparatus for the administration of medication or nutrition through thetube to the appropriate locations in the gastro-intestinal tract. Inorder to accomplish the gastro-intestinal contents removal andmedication or nutrition administration, openings 32 are provided throughthe tube 12 into the large lumen of the appropriate locations.

An important portion of the present invention involves the discoverythat the shortcomings of prior art weighted tubes can be overcome bydisposing the weighted means ahead of the lower end of the tube andremovably securing it to the tube by an extremely flexible element. Inthe apparatus 1i this is accomplished by providing a weight 34 shownbeing a thin walled rubber or plastic bag of heavy, fiowable materialsuch as mercury or water.

The bag 34 is secured to one end of an extremely flexible element suchas a surgical thread of silk or the like as. A block of plasticmaterial, rubber metal or the like 38 is secured to the opposite end ofthe thread 36. The bag 34 is removably attached to the tube 12 byinserting the block 38 in the large lumen from the lower end of thetube, the balloon 24 being in a deflated condition. When the block 38 isslightly upstream from the balloon 24, the latter is inflated bypressurizing the smaller lumen from the upper end thereof. The balloon24 in inflating blocks the larger lumen, preventing passage of the block38 thereby. Preferably the balloon 24 is positioned with respect to thelower end of the tube 12 and the thread 36 of sufficient length that asignificant amount of the extremely flexible thread 36, for instance 6-8inches thereof extends between the bag 34 and the tube 12 lower end(FIG- URE 1).

The bag 34, thread 36 and tube 12 are progressively inserted in thepatients nasal cavity in the FIGURE 1 condition thereof and allowed toprogress under the weight of the bag 34 through the esophagus, stomachand intestine. It should be apparent that because of the freedom ofmotion allowed the weighted bag 34 because of its extremely flexibleconnection to the tube 12, the bag r descends in the gastro-intestinaltract under the influence of its fluidity, weight and the peristalticaction of the stomach and intestines, pulling the tube 12 after it moreefliciently and with less chance of malfunctioning than is the case withprior art weighted tubes particularly in passing through the stomachlower end ring muscle and progressing along the small intestine.

When the tube 12 lower end has reached the desired position thereofwithin the gastro-intestinal tract, the weighted bag 34 is released fromthe tube 12 by deflating the balloon 24. This is accomplished bydisconnecting pressurization from the Y connector 26 leg 28. Uponcollapse of the balloon 24, the block 38 slips downwardly in the largelumen, past the deflated balloon and out of the lower end of the tube 12(FIGURE 4). After this separation, the bag 34, thread 36 and blockcontinue through the intestinal tract and will be eliminated from thebody in the usual manner.

If after placement of the tube has been effected and the weighted bag,thread and block released, it is desired to discontinue suction ormedication or nutrition application through the large lumen lower end,but continue such operations through the large lumen openings which areupstream from the large lumen lower end, this can be easily accomplishedby reinfiation of the balloon 24 to completely block the lower end ofthe large lumen.

When use of the tube 12 is completed, it may easily be withdrawn fromits point of entry since it no longer has the weight attached thereto.It is contemplated that in some instances, especially where the tube isintended to descend no further than into the stomach or a short distanceinto the small intestine, it may be possible to withdraw the tube afteruse without releasing the bag, thread and block.

A modification of the apparatus is shown in FIGURE 5. The apparatus ofFIGURE 5 is similar in all respects to and similarly numbered as thatshown in FIGURES 14 but for the inclusion of an electro-magnet 40 in thesmaller lumen at the lower end therof in addition to or in place of theballoon 24. Wires 42 from the electromagnet proceed upwardly in thesmall lumen and project from the upper end of the tube 12, beingconnected to a source of electric potential such as a battery 44.Preferably, switch means 46 are provided in the circuit just described.In the embodiment of FIGURE 5, the block 38 is composed offerro-magnetic material being removably retained in the large lumen ofthe tube adjacent the electro-magnet by magnetic force when the currentis flowing through the magnet, i.e. when the switch 46 is closed. Thetube of FIGURE 5 is inserted in the patients nasal cavity or mouth in asubstantially identical manner to that described in regard to the tubeshown in FIGURES 14. Release of the bag 34 when the lower end of thetube 12 has reached its desired position in the gastro-intstinal tractis accomplished by opening the switch 46, whereupon the ferro-magneticblock 38 slips out of the lower end of the large lumen. Theferromagnetic block 38, suture thread 36 and weighted bag 34 areeliminated as usual, and the tube 12 withdrawn through the patients noseor mouth when the mission it was inserted to facilitate has beencompleted.

It should now be apparent that the apparatus and method just describedefliciently and reliably accomplish each of the objects of the inventionas set forth at the outset of this specification and clearly outline theprinciples of the present invention. Because the specific embodimentsdepicted in the drawing can be considerably modified without departingfrom these principles the invention should be understood as encompassingall such modifications as are within the spirit and scope of thefollowing claims.

We claim:

1. Apparatus for applying material to and removing material from thegastro-intestinal tract and especially the small intestine comprising:an elongated flexible tube having a large lumen, a lower end and anupper end; a weight; an elongated extremely flexible element secured byone end thereof to said weight; a block secured to the opposite end ofsaid elongated extremely flexible element; said block having a lateraldimension sufiiciently small that said block is slida-bly receivable insaid large lumen; said block being removably received in said largelumen near the lower end of said tube, said elongated extremely flexibleelement extending outwardly of said tube lower end and said weightdepending therefrom; and means in said tube adjacent said block forreleasably retaining said block in said large lumen.

2. Apparatus as set forth in claim 1 wherein the portion of saidelongated flexible element which extends between the weight and the tubelower end is about 6-8 inches in length.

3. Apparatus as set forth in claim 2 wherein the elongated extremelytflexible element is a thread.

4. Apparatus as set forth in claim 1 wherein said means for releasablyretaining said block in said large lumen comprises a balloon inflatableto retain said block and deflatable to release said block.

5. Apparatus as set forth in claim 4 wherein said balloon substantiallyblocks said large lumen when inflated.

6. Apparatus as set forth in claim 4 further including means defining asmaller lumen in said tube than said large lumen, said small lumenextending from said tube upper end to and communicating with saidballoon whereby said balloon is inflatable and deflatable from said tubeupper end.

7. Apparatus as set forth in claim 6 wherein said smaller lumencomprises a flexible tube secured to the inner peripheral wall of thefirst-mentioned tube and extending longitudinally therealong.

8. Apparatus as set forth in claim 1 wherein said block is composed ofterm-magnetic material and said means for releasably retaining saidblock in said large lumen comrpises an electro-magnet.

References Cited UNITED STATES PATENTS 2,489,067 11/1949 Wild 128-27 62,919,697 1/1960 Vim 128349 3,043,309 7/1962 McCarthy 128-348 3,155,09711/1964 Barron 128-350 DALTON L. TRULUCK, Primary Examiner.

